In the sample of patients recruited from the five pharmacies in the province of Alberta, patient-perceived pharmacist expertise was an independent determinant of relationship quality, patient satisfaction, and relationship commitment. All scales showed good reliability, except for the relationship commitment scale as measured by Cronbach’s alpha. In multivariate models, patient satisfaction and relationship commitment were related to patient-perceived pharmacist expertise and relationship quality. However, patient-perceived pharmacist expertise predicted more of the variance in patient satisfaction and relationship commitment than relationship quality. Relationship quality mediated the effect of perceived expertise on patient satisfaction and relationship commitment. The relationship of self-efficacy with other variables could not be assessed due to a violation of regression assumptions.
The current findings were consistent with the findings from previous research. Worley and Schommer studied patients’ perspective of pharmacist expertise, relationship quality, and relationship commitment with the pharmacist.9
They found that the relationship quality mediated the relationship between patient-perceived pharmacist expertise and relationship commitment;9
in addition, patient–pharmacist relationship quality was highly correlated with relationship commitment.9
These findings suggest that patients viewed the pharmacist’s expertise as an important factor for sustaining a relationship with the pharmacist; however, a level of trust and satisfaction (relationship quality) must be developed between patient and pharmacist before a committed relationship can be built.
Patient-perceived pharmacist expertise significantly predicted more variance in patient satisfaction than relationship quality. The current findings also confirmed the importance of relationship quality as a mediator between patient-perceived pharmacist expertise and satisfaction. These findings suggest that patient evaluations of the pharmacist’s competence influence patient satisfaction; in addition, in order to achieve patient satisfaction with pharmacist expertise, a good relationship must be built between the patient and pharmacist. Perepelkin recently found that the respondents with lower levels of education placed more importance on pharmacist expertise and the relationship with the pharmacist than those with a higher education.30
Future studies should include patients’ level of education.
Previous research suggested that patients commonly request information on adverse effects, basic instructions, and drug interactions.31
In the current study, the following patients’ perceptions of pharmacist expertise were measured: ability to answer questions, ability to explain medication use, and ability to provide information regarding potential side effects of the medication. Patients evaluated the pharmacist’s expertise based on the pharmacist’s provision of medication information; thus the provision of medication information was an important factor for building and sustaining patient relationships.
Other findings from patient–physician relationship research were similar to the current findings. In one study, patients were able to evaluate physician technical competence; additionally, patients’ perceptions of physician competence influenced patients’ trust in physicians.32
In another study, patient-perceived physician expertise, exchange of information, patients’ trust, and the quality of the relationship significantly influenced patient satisfaction.33
The relationship of self-efficacy with perceived expertise, relationship quality, and patient satisfaction in the second model could not be analyzed due to the failure to meet the regression assumptions. This failure could be attributed to the measurement of self-efficacy, which appeared to have a ceiling effect with limited variance to explore relationships with other variables. The average age of patients was over 46 years old, and most had visited the same pharmacy for more than 1 year. This might imply that they were obtaining medications for regular chronic conditions where they potentially had high self-efficacy. Other researchers have found a positive association between patient–pharmacist relationship and self-efficacy for patients with type 2 diabetes and older adults.12
The patient–physician relationship (trust) had a significant positive association with patients’ self-efficacy expectations in patients with type 2 diabetes.34
Keshishian et al found patients had better quality relationships with their physicians than their pharmacists, and only the relationship with their physicians predicted self-efficacy for medication management.35
The findings from previous studies about the association between relationship quality and self-efficacy were based on the measurement of patient self-efficacy toward medication taking or medication management; however, patient self-efficacy was also measured in the current study to learn about medications. Further research may consider the impact of the patient–pharmacist relationship on patient self-efficacy with attention to the selection of an appropriate self-efficacy measure.
Patient-perceived pharmacist expertise predicted a greater proportion of the variance in relationship commitment than patient satisfaction. This result could be attributed to the theoretically established order of entry in the regression analysis. Another possible explanation of this result could be attributed to the measurement of satisfaction. Patients are generally satisfied with pharmacists.17
In contrast, a service gap was found in the current study by using an anchored measure of patient satisfaction. Pharmacists may have been challenged by many daily constraints (eg, workload and time constraints). Similar to other research that used this survey tool, pharmacists were not meeting patient expectations when providing patient care activities.19
This lower level of satisfaction may explain the lower explanatory power of patient satisfaction in the current research.
Other results from patient–physician relationships research were partially consistent with the current findings.36
They suggested that both physician medical competence and patient satisfaction promoted long-term relationships;36
therefore, the variation from the current results of patient–pharmacist relationships could be attributed to the differing components of the patient satisfaction construct that was measured or the differing quality of physician–patient relationships.
It was identified in this and previous studies that patient-perceived pharmacist expertise and patient–pharmacist relationship quality are important factors in building patient satisfaction and forming a committed relationship with the pharmacist. Although patients viewed pharmacist expertise as an important predictor for their satisfaction and relationship commitment with a pharmacist, the quality of the relationship is a contributing factor and requires pharmacist attention.
Strengths and limitations
This study has several strengths and limitations. The survey included instruments with established psychometric properties and was self-administered to minimize bias associated with the presence of the pharmacist. This study explored patients’ perceptions with no disease restrictions; hence, findings could be useful to understand the views of a sample with different conditions.
Results of this study should be interpreted within the context of the following limitations. First, the survey was limited to English-speaking patients or clients only; in addition, reading assessment was not performed for participants. Second, the results from the relationship commitment scale should be interpreted with caution due to the low internal consistency of the scale; however, the scale has shown an acceptable internal consistency in other studies.9
Third, patient self-report bias should also be considered because some patients may be reluctant to report their low satisfaction with pharmacists due to certain factors, such as social desirability. Fourth, sampling technique used in this study was convenience sampling, the number of patients who refused to take the survey was not collected, and the response was low; therefore, the results from this sampling cannot be generalized to the whole population. Likewise, the selection of pharmacists and pharmacies was not random; findings also cannot be generalized to the whole population. Finally, patient demographics in this study were limited to age, length of time a patient had used a particular pharmacy, the pharmacy store, and waiting time for one prescription to be prepared; therefore, the impact of gender, level of education, availability of drug coverage insurance, and long-term versus new patients, and prescriptions for chronic versus acute diseases were not explored.
Pharmacy practice implications
The results of this study have important implications for pharmacy practice, particularly because there were some consistencies with the findings of previous studies. This study identified the importance of patient-perceived pharmacist expertise and relationship quality in developing patient satisfaction and committed patient–pharmacist relationships. Community pharmacists should strive to show patients that they provide useful information and take responsibility for their health care; in addition, they should exhibit a professional attitude to reflect their expertise. These efforts can increase patient trust and satisfaction in the pharmacist and are important indicators from the patients’ perspective for developing a committed relationship. Pharmacy practice research should measure patients’ satisfaction over time for a better understanding of patients’ perceptions about the care they receive from a pharmacist. Results from research into patients’ perceptions of pharmacist expertise and relationship quality should be integrated into pharmacy school curriculum to better prepare students for patient care.
Recommendation for future research
Longitudinal data collection is needed in future research to study the influence of perceived pharmacist expertise, relationship quality, and patient satisfaction on patient self-efficacy. In addition, future studies are needed to identify other factors that are important in building relationship quality and relationship commitment between patient and pharmacist and to determine whether these survey instruments are sensitive to change. Ultimately, research is required to elucidate the pathway between these constructs and patient medication and health outcomes.